Alcohol Withdrawal and Detox
For people trying to quit drinking alcohol, detox and withdrawal may be the most difficult steps in recovery. Alcohol detox is the initial process of alcohol leaving the body. During detox, people often feel intense cravings to keep drinking, which can stop the uncomfortable symptoms of withdrawal.
Alcohol withdrawal describes the set of symptoms that go along with detox. Withdrawal occurs because the body has adjusted to the presence of alcohol. Alcohol misuse slows biological processes in cells, so the body adjusts by making these processes faster. Without alcohol, the cells now operate too quickly and cause uncomfortable symptoms.
Alcohol withdrawal treatment is a major component of treatment for alcohol addiction. Unlike most other drugs, withdrawal symptoms are not just uncomfortable — they can be deadly.
Symptoms of Alcohol Withdrawal
Alcohol withdrawal symptoms range in severity based on how much and how long a person has misused alcohol. Signs of alcohol withdrawal are both physical and psychological for most people. Mild alcohol withdrawal symptoms can range from headaches to vomiting, tremors and fatigue.
Many people will experience one or more physical symptoms, including:
- Enlarged (dilated) pupils
- Fatigue or tiredness
- Loss of appetite
- Nausea and vomiting
- Rapid heart rate
- Sweating, clammy skin
- Tremor or shakiness
- Trouble sleeping
Some people will have psychological symptoms as well, including:
- Bad or uncomfortable dreams
- Mood swings
- Trouble thinking clearly
Alcohol Withdrawal Timeline
How long does alcohol withdrawal last? The alcohol withdrawal timeline is a little different for people with mild alcohol misuse versus moderate to severe alcohol misuse.
Mild alcohol withdrawal starts at about six hours after the last drink, and it can last for one or two days. Moderate or severe withdrawal can last much longer, usually one to six days after the last drink for most people. Some severe cases may last up to one month.
After the last drink, the stages of alcohol withdrawal occur as follows:
- Zero to six hours: Cravings are present, but symptoms of withdrawal have not started.
- Six to 24 hours: Sweating, stomach ache and anxiety are common in this stage. People with severe alcohol addiction may experience tremors and hallucinations.
- 24 to 48 hours: Mild to moderate symptoms continue in this period. People with severe alcohol addiction will begin to experience hallucinations which can be visual, audio or both.
- More than 48 hours: Delirium tremens (DT), if it happens, will begin 48 hours after the last drink of alcohol.
Dangers of Alcohol Withdrawal
Delirium tremens (DT) presents one of the biggest dangers of alcohol withdrawal.
DT may begin 48 hours after the last drink for people with severe alcohol addiction. People with DT may temporarily forget who and where they are. They may have many alcohol withdrawal seizures within the span of just a few hours and it is potentially life-threatening. Other common symptoms of DT include:
- Fast heart rate (tachycardia)
- Hallucinations, seeing or hearing things that are not there
Some people may experience post-acute withdrawal syndrome (PAWS), which is continuous but mild withdrawal syndrome that happens after acute detox. PAWS can last weeks or months after initial withdrawal with lingering depression, irritability, anxiety or difficulty with memory recall.
Alcohol detox is the process of all alcohol leaving the body. When someone drinks alcohol, about half is metabolized by the body in four hours and the rest is eliminated from the body within 24 hours. The alcohol detox process begins within the first 24 hours after drinking the last alcoholic drink.
Medically Assisted Detox
How can someone safely detox from alcohol? For people with mild alcohol addiction, medical alcohol detox is not necessary. It may be uncomfortable for a day or two, but it is not life-threatening.
For more severe addictions, medically assisted detox can help prevent life-threatening complications caused by seizure and heart problems during withdrawal. There are currently no alcohol detox medications that can help make this process faster, but some medications can make it safer and more comfortable.
During medically assisted detox, clinicians use a scale called the Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar, pronounced see-wah). The CIWA scale is an objective measure of alcohol withdrawal symptoms. Higher scores mean the symptoms are more uncomfortable or more dangerous.
The CIWA scale measures symptoms like sweating, vomiting, tremors, anxiety, agitation and hallucinations. A person’s CIWA score guides the dose of medication treatment they will receive.
The most common medications used to treat alcohol withdrawal are benzodiazepines. Some examples include:
- Ativan (lorazepam)
- Librium (chlordiazepoxide)
- Valium (diazepam)
Tapering Off Alcohol
Tapering off alcohol has not been shown to be an effective strategy to avoid withdrawal symptoms. Some articles may claim to know how to taper off alcohol with an alcohol tapering schedule, but this does not make sense within the chemistry of alcohol.
Alcohol affects brain and muscle cells and changes how they signal each other. Slowly reducing alcohol consumption will not reverse this process. However, some benzodiazepine medications may be used and tapered during a medically assisted detox to help manage withdrawal symptoms.
How Long Does Alcohol Detox Last?
Alcohol detox lasts less than a week, but withdrawal symptoms can last up to a month. Extended withdrawal symptoms are sometimes treated with medication.
Mild alcohol detox can be safely done at home in an outpatient setting. People with more severe cases of addiction may need an inpatient stay due to the danger of withdrawal symptoms. Those with moderate to severe alcohol addiction should speak with a medical professional before attempting to stop using alcohol. Alcohol is one of the rare drugs that can induce fatal side effects during withdrawal.
After detox and withdrawal, treatment for addiction will continue for at least a few months. Those who detoxed in an inpatient setting will continue their treatment in the same location. People who detoxed in an outpatient setting will continue with an outpatient recovery program.
Detox is a small part of a larger addiction treatment plan. Those recovering from alcohol addiction will need additional resources like therapy and counseling during their continued treatment journey. Addiction is a chronic condition — recovery is possible but treatment is lifelong.
Finding an Alcohol Detox Center in Washington
If you or someone you know is looking for alcohol detox in Washington state, The Recovery Village Ridgefield has many treatment programs for detox and withdrawal treatment. Contact us today to learn more about treatment options and plans that can work well for your situation.
Bharadwaj, Balaji; Shivanand Kattimani. “Clinical Management of Alcohol Withdrawal: A Systematic Review.” Industrial Psychiatry Journal, 2013. Accessed July 21, 2019.
Knight, Erin; Lappalainen, Leslie. “Clinical Institute Withdrawal Assessment for Alcohol-Revised Might Be an Unreliable Tool in the Management of Alcohol Withdrawal.” 2017. Accessed July 29, 2019.
MedlinePlus. “Alcohol Withdrawal: MedlinePlus Medical Encyclopedia.” 2018. Accessed July 21, 2019.
Miller, Peter M. “Principles of Addiction. Volume 1, Comprehensive Addictive Behaviors and Disorders.” Elsevier, 2013. Accessed July 21, 2019.
UCLA Semel Institute for Neuroscience and Human Behavior. “Post-Acute Withdrawal Syndrome (PAWS).” 2019. Accessed July 21, 2019.
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